Hypertension, preeclampsia and eclampsia among HIV-infected pregnant women from Latin America and Caribbean countries

Abstract

Objectives To evaluate the incidence of and risk factors for hypertensive disorders in a cohort of HIV-infected pregnant women. Methods Hypertensive disorders (HD) including preeclampsia/eclampsia (PE/E) and pregnancy-induced hypertension, and risk factors were evaluated in a cohort of HIV-infected pregnant women from Latin America and the Caribbean enrolled between 2002-2009. Only pregnant women enrolled for the first time in the study and delivered at ≥ 20 weeks gestation were analyzed. Results HD were diagnosed in 73 (4.8%, 95%CI: 3.8%-6.0%) of 1513 patients; 35(47.9%) had PE/E. HD was significantly increased among women with a gestational age-adjusted body mass index (gBMI) ≥ 25 kg/m2 (OR=3.1; 95%CI: 1.9-5.0), hemoglobin (Hg) ≥11 g/dL at delivery (OR=2.1; 95%CI: 1.2-3.6) and age ≥35 years (OR=1.8; 95%CI: 1.1-3.2). PE/E was increased among women with a gBMI ≥25 kg/m2 (OR=3.0; 95%CI: 1.5-6.0) and Hg ≥11 g/dL at delivery (OR=2.8; 95%CI: 1.2-6.5). A previous history of PE/E increased the risk of PE/E 6.7 fold (95%CI: 1.8-25.5). HAART before conception was associated with PE/E (OR=2.3; 95%CI: 1.1-4.9) Conclusions HIV-infected women, with a previous history of PE/E, a gBMI ≥25 kg/m2, Hg at delivery ≥11 g/dL and in use of HAART before conception are at an increased risk of developing PE/E during pregnancy.

Surveillance monitoring for safety of in utero antiretroviral therapy exposures: current strategies and challenges

“…Two studies, one from Italy and one from Latin America/Caribbean, found that taking ART at conception was a risk factor for pre-eclampsia among HIV-infected women [37,38]. Another study found an increase in gestational diabetes with the increased use of ART in American women [39].…”

“…ART is hypothesized to improve some adverse birth outcomes by reversing immunosuppression and possibly by preventing in-utero HIV infection [94]. Recent studies identify maternal hypertension as the most important risk factor for adverse birth outcomes among HIV-infected women on ART both epidemiologically and at placental examination [7,15,38, 95]. Women with chronic HIV infection on ART have underlying endothelial dysfunction [96] that may be exacerbated by the stress of pregnancy and lead to systemic hypertension, poor placentation and placental insufficiency.…”

Associations between HIV, highly active anti‐retroviral therapy, and hypertensive disorders of pregnancy among maternal deaths in South Africa 2011–2013

“…The strength of the present analysis was that it differentiated between individuals who had HIV infection and did not require HAART and individuals with HIV infections/AIDS who were or were not receiving HAART when examining the proportion of maternal deaths that were due to HDP, thereby illustrating differences in the risk of HDP‐caused maternal death among patients with different levels of immune function. Previous studies, where women with HIV undergoing treatment have been compared with individuals without HIV, have not done this . To improve understanding, future studies should compare women with HIV infection who are not immune‐compromised with women with HIV infection, and should compare between women with AIDS who are, or are not, receiving HAART.…”

“…demonstrated similar findings in a retrospective study of 123 women with HIV and 1708 control patients; they reported that women with HIV, most of whom were being treated with highly active anti‐retroviral therapy (HAART), had a lower incidence of experiencing pre‐eclampsia compared with patients without HIV (0.8% vs 10.6%, respectively). However, Machado et al . reported that hypertension and pre‐eclampsia rates among women with HIV infections and pregnant individuals without HIV were comparable.…”

Adverse drug reactions associated with antiretroviral therapy during pregnancy

“…A recent report on a cohort of HIV-infected pregnant women from Latin America and Caribbean countries suggested that a previous history of preeclampsia/eclampsia, a gestational age-adjusted body mass index ‡ 25 kg/m, hemoglobin at delivery ‡ 11 g/dl and use of HAART before conception puts women at an increased risk of developing PE/E during pregnancy [96]. The inconsistencies of the available results do not permit an analysis of whether HIV increases or decreases the rate of preeclampsia and how ARV therapy affects this rate [97].…”